Birth Control

Birth Control Methods

There are many methods of birth control. Learn about the different kinds of birth control to help you choose the best one for you. When making your choice, also consider that only a condom will help protect you from sexually transmitted infections (STIs). To protect yourself and your partner against STIs, use a condom (along with your chosen birth control method) every time you have sex.

Long-acting reversible contraception (LARC)

Long-acting reversible contraception (LARC) is the best reversible method for preventing pregnancy. "Long-acting" means that they will prevent pregnancy for years. "Reversible" means that you can have them removed if you want to get pregnant later. LARC includes implants and intrauterine devices (IUDs).

• The hormonal implant (such as Nexplanon) releases progestin to prevent pregnancy for about 3 years. It must be inserted and removed by a trained health professional. The actual implant is about the size of a matchstick and is inserted under the skin on the inside of the upper arm.
• An intrauterine device (IUD) is a small device that is placed in the uterus to prevent pregnancy. There are two main types of IUDs: copper IUD (such as ParaGard) and hormonal IUDs (such as Mirena or Skyla). Hormonal IUDs release a type of progestin. When an IUD is in place, it can provide birth control for 3 to 10 years, depending on the type.

The hormonal IUD typically reduces menstrual flow and cramping over time. On the other hand, the copper IUD can cause longer and heavier periods. But the hormonal IUD can have other side effects, including spotting, mood swings, and breast tenderness. These side effects occur less frequently than with other progestin-only methods.

Hormonal methods

Hormonal methods are very reliable means of birth control. Hormonal methods use two basic formulas:

• Combination hormonal methods contain both estrogen and progestin (synthetic progesterone). Combination methods include pills ("the Pill"), the skin patch, and the ring.
• Progestin-only hormonal methods include pills, also called "mini-pills" and a shot (such as Depo-Provera). If you can't take estrogen, a progestin-only method may be an option for you. Implants and hormonal IUDs also release progestin.

Combination and progestin-only methods are prescribed for women for different reasons. Each type of method has its pros and cons.

• Combination pills may reduce acne, pain during ovulation, and premenstrual symptoms. Both types of pill reduce heavy bleeding and cramping. Unlike the combination pill, the progestin-only pill can be taken by almost all women, including those who are at risk for blood clots. Depending on when you start taking either type of birth control pill, you may need to use a backup birth control method for the first week.
• Patches or vaginal rings are similar to combination pills, but they don't require taking a daily pill. The patch is changed weekly, and the ring is changed monthly.
• Some birth control pills reduce severe mood and physical symptoms that some women get before they start their monthly periods. These symptoms are called premenstrual dysphoric disorder (PMDD). There are also birth control pills for women who want fewer periods or who want to stop having periods.
• The birth control shot does not require taking a daily pill. In most cases, you will have to see your health professional once every 3 months for the injection.

Barrier methods

Barrier methods (including the diaphragm; cervical cap; male condom; female condom; and spermicidal foam, sponge, gel, suppository, or film) prevent sperm from entering the uterus and reaching the egg. Typically, barrier methods are not highly effective, but they can have fewer side effects than hormonal methods or IUDs. Spermicides and condoms should be used together or along with another method to increase their effectiveness. Barrier methods can interrupt sex, because they must be used every time you have sex.

Condoms (male or female) should always be used if you are at risk of getting or spreading a sexually transmitted infection, such as genital herpes, chlamydia, or HIV.

Fertility awareness (periodic abstinence or natural family planning)

Fertility awareness requires that a couple chart the time during a woman's menstrual cycle when she is most likely to become pregnant and avoid intercourse or use a barrier method during that time. Fertility awareness is not a good choice if you need a highly effective form of birth control.

Breastfeeding may work as a form of birth control in the first 6 months after giving birth if you follow specific guidelines. For this method to work, you must breastfeed your baby every time. You can't use formula or other supplements. This is called the lactational amenorrhea method (LAM).

Permanent birth control (sterilization)

Sterilization is a surgical procedure done for men or women who decide that they do not want to have any (or more) children. Sterilization is one of the most effective forms of birth control. Sterilization is intended to be permanent, and although you can try to reverse it with another surgery, reversal is not always successful.

• Tubal ligation. Tubal ligation is a surgical procedure where the fallopian tubes, which carry the eggs from the ovaries to the uterus, are tied, cut, or blocked.
• Vasectomy. In this minor surgery, the vas deferens, the tubes that carry sperm from the testicles to the seminal fluid (semen), are cut and blocked so that the semen no longer contains sperm. This does not interfere with a man's ability to have an erection or enjoy sex. Men must have a sperm count check after having a vasectomy before relying on this for birth control.

Female sterilization is more complicated, has higher risks of problems after surgery, and is more expensive than male sterilization.

Contraception following pregnancy

Birth control is an important consideration after you have had a child. Your ability to become pregnant again may return within 3 to 6 weeks after childbirth. Think about what type of birth control you will be using, and make a plan during your pregnancy. Most methods of birth control are safe and effective after delivery. But in the first couple of weeks after delivery, it's best to use a method that doesn't contain estrogen. Talk to your doctor about which type is best for you.

Choosing a Birth Control Method

With so many methods available and so many factors to consider, choosing birth control can be difficult. You may be able to decide on a method by asking yourself the following questions:

Might I want to have a biological child in the future?

One of your first considerations might be to determine whether you want permanent or temporary birth control. In other words, you should consider whether you want to conceive any (or more) children. This is a decision that will affect the rest of your life and can be made only after thinking it through carefully.

If you know that you will not ever want to conceive a pregnancy, tubal ligation for you or a vasectomy for your partner is a reasonable option to consider.

If you are not sure about the future even though you know how you feel now, a temporary method is a better choice. If you are young, have few or no children, are choosing sterilization because your partner wants it, or think it will solve money or relationship problems, you may regret your decision later.

How much effort am I willing to put into my birth control?

Some birth control methods require more effort than others. Be honest about how much effort you are willing to put into birth control. Birth control must be used correctly in order to prevent pregnancy. If you are not comfortable with or might not consistently use a birth control method for any reason, that method is not likely to be reliable for you in the long run.

• Long-acting reversible contraception (LARC) (such as implants and IUDs) works to prevent pregnancy for 3 to 10 years. Once it is in place you don't need to do anything.
• Hormone shots are needed every 3 months.
• Barrier methods (including the diaphragm; cervical cap; male condom; female condom; and spermicidal foam, sponge, gel, suppository, or film) can interrupt sex and must be used every time you have sex.
• Combination pills are taken each day. Progestin-only pills must be taken at the same time each day. If you miss a pill you will need to use a backup birth control method.
• Patches are replaced 3 times each month.
• Vaginal rings are inserted into the vagina one time each month.
• Fertility awareness requires that a couple chart the time during a woman's menstrual cycle when she is most likely to become pregnant and avoid intercourse or use a barrier method during that time.
• Sterilization is a surgical procedure done for men or women who decide that they do not want to have any (or more) children. Sterilization is intended to be permanent.

How would an unplanned pregnancy affect my life?

If an unplanned pregnancy would seriously impact your plans for the future, choose a birth control method that is highly effective. If an unplanned pregnancy would be welcome, you may feel comfortable using a less reliable method.

How effective are different types of birth control?

Consider how important it is to you to avoid pregnancy, and then look at how well each birth control method works. Hormonal methods and IUDs work very well. Barrier methods such as condoms, diaphragms, and spermicides are only moderately effective. Fertility awareness is even less effective.

To be effective, birth control pills require you to take a pill every day. Barrier methods have to be used before sex. Fertility awareness requires that you watch your temperature and other signs closely. You must also avoid sex on days when you could get pregnant.

Consider how comfortable you feel about using a particular method of birth control. If you are not comfortable with or might not consistently use a birth control method for any reason, that method is not likely to be reliable for you in the long run.

How can I prevent sexually transmitted infections?

Unless you know that your partner has no other sex partners and is free of sexually transmitted infections (STIs), you are at risk for STI infection. If you are at risk, protect yourself from infection every time you have sex. Use a condom in addition to any other birth control method you choose.

You can choose between a male or female condom to reduce your risk for HIV (the virus that causes AIDS), gonorrhea, syphilis, chlamydia, genital warts, herpes, pelvic inflammatory disease (PID), and other infections.

What health factors could limit my choice of birth control?

If you have health problems or other risk factors, some birth control methods may not be right for you.

• Smoking. If you smoke more than 15 cigarettes a day and are 35 or older or have high blood pressure, a history of stroke, a history of blood clots, liver disease, or heart disease, you may not be able to use combined hormonal methods.
• Migraines. If you have migraine headaches, talk to your health professional about whether you can try combined hormonal contraception.
• Diabetes. If you have advanced or long-standing diabetes, discuss the risks of taking hormonal birth control methods with your health professional.
• Childbirth. If you have just delivered a baby, the estrogen-progestin methods of birth control aren't recommended in those first few weeks. Progestin-only pills, an implant, both kinds of IUDs, or birth control shots are a good option for women who have just given birth.

Other health problems that might keep you from using a particular birth control method are relatively rare, especially in young women. But before using any method, talk with your health professional to see if it is safe for you.

What are some other considerations in choosing a birth control method?

Other things to consider when choosing a method of birth control include:

• Health benefits, such as decreased risk of sexually transmitted infections with condoms and reduced risk of ovarian cancer and uterine cancer with use of birth control pills for one year or longer.
• Cost. Over time, the higher one-time cost of IUD insertion or sterilization surgery may be less than the continued costs of buying pills or condoms and spermicide.
• If you are planning to become pregnant in the future. The amount of time it takes for a woman's full fertility to return after stopping birth control varies for each woman and depends on the birth control method she is using.
• Risks and side effects of the method. Some birth control methods may have a greater risk of causing certain health problems. And some methods cause more side effects than others. For example, hormonal birth control can have more risks and side effects than barrier methods. Talk to your doctor about the risks and side effects.

Thinking about the pros and cons of hormonal birth control methods may help you choose the one that is best for you.

After you have looked at the facts about the different methods and thought about your own values and needs, you can choose the method that will work best for you. Using condoms with any method may increase its reliability and helps to protect you from sexually transmitted infections (STIs).

Emergency Contraception

You can use emergency contraception if a condom breaks, you've forgotten a pill, you are taking other medicines that may affect contraception medicines, or you have had unprotected sex. Emergency contraception does not protect against sexually transmitted infections.

When to Call a Doctor

Call 911 or other emergency services if you have:

• Sudden, severe chest pain.
• Difficulty breathing.
• Sudden, severe headache.

Call your doctor now if you:

• Have severe pain in your belly.
• Have headaches that:
  • Happen more often.
  • Are getting worse.
  • Start with auras, such as seeing spots, wavy lines, or flashing lights. Your hands, arms, or face may tingle or feel numb.
• Have signs of a blood clot, such as:
  • Pain in your calf, back of the knee, thigh, or groin.
  • Redness and swelling in your leg or groin.
• Feel depressed.
• Have heavy or prolonged bleeding.
• Think you may be pregnant.
• Notice yellowing of your skin or eyes.

It's common to have mild headaches, mild nausea, mild breast tenderness, or irregular bleeding (spotting) when starting birth control. These mild symptoms should improve over time. If you have problems with a birth control method, talk with your doctor. They may recommend another birth control method or help you solve the problem you are having.